Designing a primary care intervention with the Behaviour Change Wheel: the case of maternal Indigenous smoking

Introduction: Clinicians seldom perform all recommended components of smoking cessation care (SCC) for pregnant Indigenous women, whose smoking rates are 47% in pregnancy. We developed an intervention to improve culturally competent SCC for pregnant Indigenous smokers, using the Behavior Change Wheel (BCW) as a parsimonious model governing capability, opportunity and motivation for behavioral interventions. Methods: Indigenous Counselling and Nicotine (ICAN) QUIT in Pregnancy is a smoking cessation program based on Gould’sS180 Int.J. Behav. Med. (2016) 23 (Suppl 1):S1–S261“Pragmatic Guide” to smoking cessation - the ABCD (Ask/Assess; Brief advice; Cessation: Discuss) approach. We identified evidence-practice gaps by conducting: two systematic literature reviews on provider attitudes and interventions for SCC in pregnancy; a national survey of Australian clinicians; and gathering stories of smoking and quitting from Aboriginal mothers. These studies facilitated the development of this targeted intervention. Results: Areas identified for performance improvement included: capability (psychological skills), motivation (optimism), and opportunity (resources/time). According to the BCW, interventions to improve: capability by training clinicians in pharmacotherapy to assist women to quit; opportunity by structuring the consultation using a flipchart and prompts; and optimism for success by presenting recent evidence, and positive testimonials from patients and clinicians. Webinar will bring the training to the services to accommodate time and location constraints. A Stakeholder and Consumer Aboriginal Advisory Panel was consulted on developing these intervention materials. Conclusions: Training may improve gaps in SCC, i.e. counselling skills and pharmacotherapy management. ICAN QUIT in Pregnancy is uniquely designed to improve the implementation of evidence based SCC for expectant mothers attending primary care services.